Each month in Boyz the team from NAM aidsmap report the latest news on HIV and sexual health. This month, they bring you the news from the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, USA, which is the most important HIV conference of the year. You can also keep up to date and read more on their website at aidsmap.com.
A London man who had been living with HIV for over a decade no longer has any traces of the virus in his body after undergoing a bone marrow transplant to treat cancer. He stopped taking anti-HIV medications a year and a half ago. The news was announced at a major HIV scientific conference in Seattle earlier this month by Professor Ravindra Gupta of University College London.
This case is the only the second reported case of an adult apparently becoming free of HIV infection. The first case, Timothy Ray Brown, known as the Berlin patient, was reported twelve years ago and involved a similar procedure. Brown was at the conference in Seattle and told NAM’s reporter that he was excited to hear that another person may have been cured of HIV. “I consider him my sibling and I can’t wait to meet him,” he said.
In both cases, the procedure was only done because the men needed bone marrow transplants for life-threatening blood cancers. Their doctors selected donors who lacked a cell-surface molecule called CCR5, which allows HIV to bind to certain cells and infect them. People who don’t have it are almost totally resistant to infection with HIV.
The London man’s transplant led to complete remission of his cancer but also seems to have cleared HIV from his body. For the moment Professor Gupta is cautious about describing it as a ‘cure’. The man has only been off HIV treatment for 18 months and his HIV could still reappear.
Some media outlets have talked about a third person cured, but that person only stopped taking treatment four months ago, so it is far too early to tell.
Does this change anything for people living with HIV? Not now. Bone marrow transplant is a life-threatening procedure in itself. The gruelling treatment would not be right for someone who did not have cancer. Furthermore only one in a hundred transplant donors have the rare genetic mutation that is needed and some other attempts to try this procedure have failed.
But the case does show that Timothy Ray Brown was not a one-off. It is a proof of concept that manipulating the CCR5 receptor could be a potential path to an HIV cure.
Big drops in HIV and hepatitis C
Two pieces of very encouraging news from the UK were announced at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.
Firstly, the rate of new HIV infections in gay and bisexual men attending UK sexual health clinics fell by 55% in just two years. The figures were presented by Dana Ogaz of Public Health England and are based on men who went to the same clinic twice or more in the same year. This group may not be representative of all gay men though.
In 2012-13, incidence was 1.9% (meaning that two in every 100 men acquired HIV during the year), remaining stable at 1.8% in 2014-15. But two years after that, incidence was only 0.8%.
The reduction in HIV infections coincides with a period in which more men have been taking the preventative pill PrEP. At the same time, efforts to get people to test regularly and to start HIV treatment promptly have continued.
Secondly, new cases of hepatitis C in HIV-positive gay and bisexual men attending three London clinics have fallen by nearly 70% since 2015. The drop is due to regular testing for hepatitis C (which picks up infections early) and more people taking modern hepatitis C treatments (which clear the hepatitis C virus from the body).
“Our study has shown that greater access to new treatments, closer monitoring and screening can greatly reduce hepatitis C cases,” Dr Lucy Garvey of Imperial College Healthcare told the conference.
But being cured does not give you immunity to hepatitis C. Some people who are treated and cured of hepatitis C pick it up again through risky sex or sharing equipment to inject or snort drugs.
Injectable HIV treatment
Another big story from the conference was about new drugs for HIV treatment which can be taken as monthly injections. Studies showed that they work just as well as the usual daily pills and that many people prefer them. This might be because they aren’t reminded of HIV each day or don’t need to hide tablets from people around them.
The drugs are called cabotegravir and rilpivirine. Before beginning the injections, you need to take these same drugs as daily pills for a month. After that, you go to a clinic to have the injections, given in the buttocks, once a month. It’s quite common to find the injections painful the first few times they are given, but most people get used to them.
These injectable drugs haven’t yet been approved by regulators, but probably will be in the next year or two.
Read more at aidsmap.com/page/3465059
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